OC-072 Use Of A Novel Self-expanding Metal Stent To Allow For Endoscopic Drainage And Necrosectomy Of Pancreatic Fluid Collections

Abstract

Background: Post-inflammatory peri-pancreatic fluid collections are frequent sequelae of severe acute pancreatitis. Recently, a novel flanged fully covered self-expanding metal stent (FCSEMS; NAGI stent, Taewoong Medical, Korea) has been developed, allowing for better EUS-guided drainage of infected necrosis and easier endoscopic access into the cavity. Aims: To determine the safety and efficacy of FCSEMS endoscopic cystgastrostomy in the management of complex/infected pancreatic fluid collections. Patients & methods: Patients were included if they had evidence of a pancreatic fluid collection which was amenable for EUS- guided drainage. The collection was punctured using a cystotome and the FCSEMS inserted over a guidewire with fluoroscopic control. Repeat procedures were performed as necessary. Results: A total of 11 patients (8 male, 3 female) were included. Median age was 57.3 years. The aetiology of the collection was gallstones in 6 patients, idiopathic in 3, ischaemic in 1 and drug-induced in 1. Ten patients had evidence of at least 30% necrosis within the collection. Mean diameter of the collection was 15cm and EUS-guided puncture was initially performed in all patients. Ten patients underwent endoscopic necrosectomy, with a median of 3 procedures (range 1-10). Significant reduction in the size of collection was achieved in all patients. Adverse events included stent migration in 3 (2 spontaneously and 1 during necrosectomy). Two patients died of complications of severe acute pancreatitis. Conclusion: FCSEMS insertion is feasible and safe for drainage of pancreatic fluid collections. It allows repeated through the stent necrosectomy procedures and is a major advance in the management of infected pancreatic necrosis.